Can value -based care help counteract the consolidation trend?

During a committee on February 25th for the value -oriented payment summit, experts discussed challenges and some potential solutions to combat consolidation in healthcare and made it possible to remain independent. Among other things, the discussion participants have addressed some options to use value -oriented care models in order to provide more stable and foreseeable payments for independent practices.

Erica Sicker, Ph.D., Vice President of Health and Payer Reform at the evidence-based philanthropy organization Arnold Ventures, put the stage by finding that the number of small, independent practices has decreased significantly, and at the same time. A great growth of consolidation on the health markets. It excluded three relevant actors: the hospitals and large health systems; Private equity, especially in special care; And the insurers. (It has increased to an increase in the acquisition of insurers of basic care practices, she noticed.)

From the point of view of these organizations, said SOCKER, it basically encounters revenue strategies that they pursue on the commercial market. “The more market power that can collect hospitals and health systems, you can negotiate higher installments with insurers. It really affects her negotiating power, so that is really important, ”she said.

There are areas in which payment guidelines encourage consolidation, added SOCKER. “A special example of this is the Medicare program, and many private insurers also pay higher hospital prices if the same service is delivered in a hospital complex compared to an independent doctor's office. This creates incentives for hospitals to buy the doctor's office, convert them into an outpatient hospital, and now you can get a higher refund or exactly the same service, sometimes even delivered by the same doctor. “

Soccer emphasized three areas in which political changes could help. One claims the payment problems that contribute to consolidation and the ability of consolidated companies to extract higher payment rates if they accumulate more market power. “You could do things like the determination of the payment differences between the independent medical practices and the outpatient departments of the hospital,” she said, adding that another area that deserves attention deserves competition and increase prices in different ways.

She said there are also ways to reduce the administrative burden for independent practices. “We could do more to optimize the prior approval. We could do more to optimize quality reporting. I also think we have to think about creating a more stable, more sustainable payment system and a medical program. “

Farzad Mostashari, MD, CEO of Aledade Inc., which runs the largest network of independent primary care in the country, said that consolidation in healthcare is different than in production or in other sectors. “It's not like combining or rolling up and scaling automobile manufacturers, so produce it cheaper and qualitatively high. In healthcare, when these private practices are bought up, the evidence mainly shows that the quality does not improve and the costs do not decrease. They actually go up. I think this is a really important piece of context for why private independent practice is continued. “

Mostashari said that Sockker is absolutely right that there is a payment difference, and not just in terms of location neutral payments. “It is shocking and looks at some of the price transparency data published lately. A very considerable percentage of the independent practices of basic care receives the commercial prices less than medicar.” Conventional wisdom is always that the commercial prices of Medicare radically subsidize too low, but it turns out to be private payers, he added.

Mostahari found that independent practices in the price negotiations for service are worth the value of fees, while in value -oriented care there is mostly evidence that they have an advantage. “And in Medicare Shared Sparing Program you have twice as many common savings as all of these chic health systems. So I would say that encouraging and feasible value -based payment should be on the list as part of the basic supply. “

He said one of the big improvements that CMS had made, be it to start with the treatment of the large Medicare Shared Savings Program (MSSP) as a chassis for testing new functions. According to Mostashari, the Flex model of basic care asked the question of whether the switch to capitalized and predictable monthly payments would contribute to improving the savings rates in advance. Instead of finding a completely new model with new benchmarking, new trends, new risk adjustments, new attributions. “I think we have 250,000 of the 350,000 lives in PC Flex,” he said. “We are a large scale because we really believe that a more investment of the independent practices of basic care can enable more investments from financing forward and can lead to increasing the savings rate. So I am confident that this is the approach that is pursued even further in relation to the MSSP as a chassis. “

The committee spoke about the challenges of the practices that were independent after a larger health system. Mostashari said that Aledade was six to a dozen practice outside the hospital in an independent practice, and three things were obstacles. One is the wage rates. You can be part of the clinically integrated network of a hospital that calculates a higher rate from increasing your market power. If a practice leaves this CIN, the rates they receive from the Blue Cross plan would be considerably lower and they could not maintain the economy of their practice. Barrier two, he said, is what you need scale for. He said you actually need scaling, not only for the contract acceptance, but you also have to have a minimal sample size and a risk -size size. You also need scaling for purchase technology and data and interfaces.

“For this reason, we have created Aledade to create a way to integrate and bring the advantages of scaling and technology as well as scaling as well as a contract and value -oriented risk without consolidation.”

The third barrier, he added, contains non -competitive clauses. In certain markets, the hospitals were very hard when it came to enforcing five years/50 mile-not-competence, which this independent practice essentially excludes from practice in their own community.